Refluks żółciowy – Charakterystyka, pielęgnacja i opieka

Refluks żółciowy
Charakterystyka, pielęgnacja i opieka

Refluks żółciowy to patologiczny stan, w którym żółć cofa się do żołądka, a czasem do przełyku, powodując zapalenie błony śluzowej tych narządów. W odróżnieniu od refluksu kwasowego, mechanizm ten wynika z dysfunkcji zastawki uniemożliwiającej cofanie się żółci, co prowadzi do erozji i zapalenia przełyku oraz żołądka. Najczęstszymi przyczynami są powikłania pooperacyjne (np. po resekcji żołądka lub operacjach bariatrycznych), usunięcie pęcherzyka żółciowego oraz nieprawidłowa funkcja odźwiernika. Objawy obejmują m.in. nocne cofanie się treści, ból nadbrzusza, dysfagię, nudności, a także zmiany w jamie ustnej i gardle. Diagnostyka wymaga szczegółowego wywiadu, badania fizykalnego oraz często konsultacji gastroenterologicznej, zwłaszcza u pacjentów z opornością na standardowe leczenie GERD.

Definicja i patofizjologia refluksu żółciowego

Przyczyny refluksu żółciowego

Objawy i diagnostyka refluksu żółciowego
Powikłania refluksu żółciowego
Leczenie refluksu żółciowego

Leczenie farmakologiczne
Leczenie chirurgiczne

Opieka pielęgniarska w refluksie żółciowym

Ocena pacjenta
Interwencje pielęgniarskie
Edukacja pacjenta

Szczególne aspekty refluksu żółciowego w praktyce klinicznej

Refluks żółciowy u pacjentów wentylowanych mechanicznie
Refluks żółciowy po cholecystektomii
Refluks żółciowy a przełyk Barretta

Zalecenia dla pacjentów z refluksem żółciowym
Zintegrowane podejście do leczenia refluksu żółciowego

Kolejne rozdziały

Definicja i patofizjologia refluksu żółciowego

Refluks żółciowy to stan, w którym żółć – płyn trawienny wytwarzany w wątrobie – cofa się (ulega refluksowi) do żołądka, a w niektórych przypadkach również do przełyku, czyli przewodu łączącego jamę ustną z żołądkiem.¹² W przeciwieństwie do refluksu kwasu żołądkowego, refluks żółciowy występuje, gdy zastawki uniemożliwiające cofanie się żółci do żołądka i przełyku nie funkcjonują prawidłowo.³

Żółć składa się ze składników przeznaczonych do trawienia tłuszczu. Mimo że nie jest to formuła kwasowa, jest agresywna dla delikatnych wyściółek żołądka i przełyku. Przewlekły refluks żółciowy może powodować erozję tych ochronnych wyściółek, wywołując bolesny stan zapalny, a ostatecznie uszkodzenie tkanki (zapalenie przełyku).⁴ W przypadkach refluksu żółciowego zastawka nie zamyka się prawidłowo, a żółć cofa się do żołądka, co może prowadzić do zapalenia błony śluzowej żołądka (zapalenie żołądka wywołane refluksem żółciowym).⁵

Przyczyny refluksu żółciowego

Refluks żółciowy może być spowodowany przez:⁶⁷

Powikłania chirurgiczne – operacje żołądka, w tym całkowite lub częściowe usunięcie żołądka oraz operacje bariatryczne (bypass żołądkowy) w celu redukcji masy ciała, są odpowiedzialne za większość przypadków refluksu żółciowego⁸
Usunięcie pęcherzyka żółciowego – osoby, które miały usunięty pęcherzyk żółciowy, doświadczają znacznie częściej refluksu żółciowego niż osoby, które nie przeszły tego zabiegu⁹
Nieprawidłowo funkcjonujący lub szeroko otwarty odźwiernik, który może predysponować pacjentów do tego stanu¹⁰

Objawy i diagnostyka refluksu żółciowego

Objawy refluksu żółciowego są często podobne do objawów refluksu kwasowego, co może utrudniać diagnostykę. Ocena stanu pacjenta z podejrzeniem refluksu żółciowego powinna obejmować:¹¹¹²

Zgłaszane przez pacjenta objawy subiektywne: nocne cofanie się treści pokarmowej, kaszel lub dławienie się, dysfagia, ból w nadbrzuszu, nietolerancje pokarmowe, zmiany smaku, ból gardła, utrata masy ciała, przebarwienia zębów, nudności i wymioty, trudności ze snem, niepokój
Ocena objawów obiektywnych: parametry życiowe, charakterystyka bólu, masa ciała, badanie jamy ustnej i gardła, osłuchiwanie dźwięków oddechowych, poziom niepokoju, wiedza o przebiegu choroby, wywiad żywieniowy

Osoby z refluksem żółciowym, które nie reagują odpowiednio na standardowe leczenie GERD (choroby refluksowej przełyku), mogą wymagać dodatkowej diagnostyki.¹³ Po wstępnej ocenie lekarz może skierować pacjenta do specjalisty chorób układu pokarmowego (gastroenterologa).¹⁴

Powikłania refluksu żółciowego

Przewlekły refluks żółciowy może prowadzić do poważnych powikłań zdrowotnych:¹⁵¹⁶

Przewlekłe zapalenie błony śluzowej żołądka (zapalenie żołądka) może prowadzić do wrzodów żołądka i jest związane z wyższym ryzykiem raka żołądka
Zapalenie przełyku (zapalenie błony śluzowej przełyku) może powodować owrzodzenia, bliznowacenie i zmiany komórkowe w wyściółce (przełyk Barretta), które okazjonalnie mogą poprzedzać rozwój raka przełyku
Zapalenie żołądka wywołane refluksem żółciowym zostało powiązane z rakiem żołądka¹⁷

Kombinacja refluksu żółciowego i refluksu kwasowego dodatkowo zwiększa ryzyko tych powikłań. Żółć jest często podejrzewana o przyczynianie się do GERD, gdy pacjenci niepełnie reagują lub wcale nie reagują na silne leki hamujące wydzielanie kwasu.¹⁸

Leczenie refluksu żółciowego

W przeciwieństwie do refluksu kwasu żołądkowego, refluks żółciowy nie może być całkowicie kontrolowany przez zmiany w diecie lub stylu życia. Leczenie obejmuje stosowanie leków lub, w ciężkich przypadkach, zabiegi chirurgiczne.¹⁹²⁰

Leczenie farmakologiczne

Personel medyczny przepisuje różne leki w celu leczenia refluksu żółciowego i jego objawów, chociaż nie zostały one dokładnie przebadane.²¹ Leki stosowane w leczeniu refluksu żółciowego obejmują:²²

Kwas ursodeoksycholowy (UDCA), który zmienia skład żółci w żołądku
Sekwestranty kwasów żółciowych, które wiążą i zakłócają krążenie żółci
Sukralfat, który pokrywa i chroni błonę śluzową żołądka i przełyku
Środki prokinetyczne, które stymulują motorykę między żołądkiem a jelitem cienkim (np. metoklopramid)²³
Baklofen, lek zmniejszający rozluźnienie dolnego zwieracza przełyku poprzez działanie agonistyczne na receptory GABA-B²⁴

Ważne jest również przegląd listy leków pacjenta i ograniczenie leków, które mogą upośledzać motorykę żołądkowo-dwunastniczą, takich jak opioidy i leki przeciwcholinergiczne.²⁵

W przeciwieństwie do refluksu kwasowego, refluks żółciowy nie może być leczony dostępnymi bez recepty lekami zobojętniającymi kwas lub zmianami w diecie. Refluks żółciowy jest trudny w leczeniu nawet przy użyciu leków na receptę.²⁶

Leczenie chirurgiczne

Lekarze mogą zalecić operację, jeśli leki nie łagodzą ciężkich objawów lub występują zmiany przedrakowe w żołądku lub przełyku.²⁷²⁸ Niektóre rodzaje operacji mogą być bardziej skuteczne niż inne, dlatego ważne jest, aby dokładnie omówić wszystkie za i przeciw z lekarzem.²⁹

Dostępne są następujące metody chirurgiczne:

Roux-en-Y – podczas tego typu operacji chirurg tworzy nowe połączenie do odpływu żółci dalej w jelicie cienkim, odprowadzając żółć z dala od żołądka³⁰
Fundoplikacja – część żołądka najbliższa przełykowi jest owijana, a następnie przyszywana wokół dolnego zwieracza przełyku. Zabieg ten wzmacnia zastawkę i może zmniejszyć refluks kwasowy. Jednak istnieje niewiele dowodów na skuteczność tej operacji w przypadku refluksu żółciowego³¹

Opieka pielęgniarska w refluksie żółciowym

Opieka pielęgniarska nad pacjentem z refluksem żółciowym obejmuje następujące działania:³²³³³⁴

Ocena pacjenta

Szczegółowa ocena objawów: ból nadbrzusza, trudności w połykaniu, nietolerancje pokarmowe
Monitoring parametrów życiowych i wagi
Ocena stanu odżywienia i tolerancji pokarmów
Ocena poziomu lęku i wiedzy pacjenta na temat choroby

Interwencje pielęgniarskie

Zarządzanie bólem nadbrzusza
Promowanie unikania leków i pokarmów wyzwalających objawy
Zachęcanie do modyfikacji diety zgodnie z zaleceniami
Wspieranie spokojnej atmosfery
Zachęcanie do rutynowego monitorowania wagi
Promowanie technik relaksacyjnych
Włączanie pacjenta w tworzenie planu edukacyjnego
Podawanie leków zgodnie z zaleceniami

Edukacja pacjenta

Plan edukacyjny dla pacjenta z refluksem żółciowym powinien zawierać:³⁵

Ogólne informacje o diagnozie i metodach leczenia
Rozpoznawanie progresji objawów
Zmiany w diecie i stylu życia
Dostępne zasoby wsparcia
Informacje o przepisanych lekach i instrukcje ich przyjmowania
Wskazówki dotyczące zgłaszania skutków ubocznych leków
Kiedy skontaktować się z lekarzem (nasilenie bólu lub objawów, pytania lub obawy dotyczące stanu lub opieki)
Zalecenia dotyczące dalszej obserwacji przez personel medyczny

Szczególne aspekty refluksu żółciowego w praktyce klinicznej

Refluks żółciowy u pacjentów wentylowanych mechanicznie

Wcześniejsze badania z wykorzystaniem scyntygrafii udokumentowały wysoką częstość występowania (61%) refluksu żołądkowo-przełykowego u pacjentów wentylowanych mechanicznie (MV).³⁶ Badania wykazały, że 50% pacjentów wentylowanych mechanicznie ma patologiczny refluks żółciowy, a tylko niewielki odsetek ma znaczący refluks kwasowy.³⁷³⁸

Obecność soli żółciowych w przełyku przez dłuższy czas sugeruje, że:³⁹⁴⁰

Funkcja barierowa dolnego zwieracza przełyku (LES) i funkcja oczyszczająca przełyku są zaburzone
Zapalenie przełyku u tych pacjentów może być nie tylko wynikiem mechanicznego podrażnienia spowodowanego przez sondę nosowo-żołądkową, ale może być również chemicznym zapaleniem przełyku
Płyny jelitowe cofające się do przełyku mogą sprzyjać rozwojowi zapalenia płuc związanego z wentylacją mechaniczną

Refluks żółciowy po cholecystektomii

Analizy pokazują, że cholecystektomia (usunięcie pęcherzyka żółciowego) zwiększa częstość występowania refluksu żółciowego oraz uszkodzeń błony śluzowej żołądka i przełyku wywołanych żółcią.⁴¹ Ryzyko refluksu żółciowego i uszkodzenia błony śluzowej jest prawdopodobnie najwyższe u pacjentów z GERD, którzy przechodzą nieuzasadnioną cholecystektomię.⁴²

Refluks żółciowy a przełyk Barretta

Refluks żółciowy lub refluks dwunastniczo-żołądkowy został zaproponowany w etiologii przełyku Barretta, ponieważ kwasy żółciowe znaleziono w treści refluksowej u pacjentów z tym schorzeniem. Sugeruje się, że kwasy żółciowe mogą wpływać na błonę śluzową przełyku poprzez szlaki cytotoksyczne i regulację protoonkogenu i c-myc, powodując stan zapalny i przyczyniając się do kaskady zapalenie-rak.⁴³

Niewystarczające hamowanie wydzielania kwasu, zdefiniowane przez monitoring impedancyjno-pH, jest modyfikowalnym czynnikiem ryzyka i zwiększa ryzyko nawrotu metaplazji jelitowej po endoskopowym leczeniu erozyjnym. Trwający refluks w dystalnej części przełyku, zarówno kwasowy, jak i niekwasowy, jest również związany z niepełną odpowiedzią na leczenie endoskopowe.⁴⁴

Zalecenia dla pacjentów z refluksem żółciowym

Podczas gdy modyfikacje stylu życia i leki mogą być bardzo skuteczne w przypadku refluksu kwasowego do przełyku, refluks żółciowy jest trudniejszy w leczeniu. Istnieje niewiele dowodów oceniających skuteczność leczenia refluksu żółciowego, częściowo ze względu na trudność w ustaleniu refluksu żółciowego jako przyczyny objawów.⁴⁵⁴⁶

W przeciwieństwie do refluksu kwasowego, refluks żółciowy wydaje się nie być związany z czynnikami stylu życia. Jednak ponieważ wiele osób doświadcza zarówno refluksu kwasowego, jak i refluksu żółciowego, objawy mogą być złagodzone przez zmiany w stylu życia:⁴⁷⁴⁸

Zmniejszenie porcji posiłków
Unikanie jedzenia przed snem
Unikanie leków, które mogą upośledzać motorykę żołądkowo-dwunastniczą
Konsultacja z lekarzem w przypadku objawów refluksu, które nie ustępują lub przy utracie wagi bez próby odchudzania się

Pacjenci z refluksem żółciowym powinni zadać lekarzowi następujące pytania:⁴⁹⁵⁰

Czy mam refluks żółciowy?
Jakie podejście do leczenia Pan/Pani zaleca?
Czy istnieją jakieś skutki uboczne związane z tymi metodami leczenia?
Czy istnieją jakieś zmiany w stylu życia lub diecie, które mogę wprowadzić, aby pomóc zmniejszyć lub zarządzać moimi objawami?
Mam inne schorzenia. Jak mogę najlepiej je wspólnie kontrolować?

Zintegrowane podejście do leczenia refluksu żółciowego

Nowoczesne podejście do leczenia refluksu żółciowego wymaga zintegrowanej, multidyscyplinarnej opieki, która łączy specjalistów z różnych dziedzin:⁵¹⁵²

Gastroenterologów
Chirurgów
Otolaryngologów (specjalistów od ucha, nosa i gardła)
Radiologów
Specjalistów od zaburzeń motoryki
Dietetyków
Pielęgniarki
Logopedów (w przypadkach zaburzeń połykania)

Ten zespół jest dedykowany do oceny i indywidualnego planu opieki, aby sprostać unikalnym potrzebom i preferencjom każdego pacjenta. Specjaliści pracują ściśle ze sobą, aby zapewnić wszechstronną opiekę od diagnozy po leczenie.⁵³

Jeśli operacja jest częścią planu leczenia, chirurdzy specjalizujący się w tego typu zabiegach mogą wykorzystać najnowocześniejsze technologie i wykonać operacje prawie całkowicie przy użyciu minimalnie inwazyjnych technik. Zalety takich metod obejmują:⁵⁴

Mniejsze nacięcia, mniejszy ból i mniejsze zapotrzebowanie na leki przeciwbólowe
Krótszy pobyt w szpitalu
Szybszy powrót do zdrowia z wcześniejszym powrotem funkcji jelit i wznowieniem jedzenia
Wcześniejszy powrót do pracy/pełnej aktywności

Kolejne rozdziały

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Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Bile reflux – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/symptoms-causes/syc-20370115
Bile reflux occurs when bile a digestive liquid produced in your liver backs up (refluxes) into your stomach and, in some cases, into the tube that connects your mouth and stomach (esophagus). […] Unlike gastric acid reflux, bile reflux can’t be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery. […] Make an appointment with your doctor if you frequently experience symptoms of reflux, or if you’re losing weight without trying. […] If you’ve been diagnosed with gastroesophageal reflux disease (GERD) but aren’t getting enough relief from your medications, call your doctor. You may need additional treatment for bile reflux. […] In cases of bile reflux, the valve doesn’t close properly, and bile washes back into the stomach. This can lead to inflammation of the stomach lining (bile reflux gastritis).
#2 Bile Reflux: Symptoms, Treatment, Causes & What It Is
https://my.clevelandclinic.org/health/diseases/22056-bile-reflux
Bile reflux occurs when the valves that keep bile from backwashing into your stomach and esophagus arent working properly. Bile can erode the delicate linings of your stomach and esophagus, causing inflammation and tissue damage. […] Bile reflux occurs when bile from the small intestine backwashes into the stomach, and sometimes into the esophagus. […] Bile is composed of ingredients designed to digest fat. While it isnt an acidic formula, its harsh on the sensitive linings of your stomach and esophagus. Chronic bile reflux can erode these protective linings, causing painful inflammation and, eventually, tissue damage (esophagitis). […] Chronic inflammation of your stomach lining (gastritis) can lead to stomach ulcers and is associated with a higher risk of stomach cancer. Inflammation of your esophagus (esophagitis) can cause ulcers, scarring and cellular changes to your lining (Barretts Esophagus), which is occasionally a precursor to esophageal cancer.
#3 Bile Reflux: Symptoms, Treatment, Causes & What It Is
https://my.clevelandclinic.org/health/diseases/22056-bile-reflux
Bile reflux occurs when the valves that keep bile from backwashing into your stomach and esophagus arent working properly. Bile can erode the delicate linings of your stomach and esophagus, causing inflammation and tissue damage. […] Bile reflux occurs when bile from the small intestine backwashes into the stomach, and sometimes into the esophagus. […] Bile is composed of ingredients designed to digest fat. While it isnt an acidic formula, its harsh on the sensitive linings of your stomach and esophagus. Chronic bile reflux can erode these protective linings, causing painful inflammation and, eventually, tissue damage (esophagitis). […] Chronic inflammation of your stomach lining (gastritis) can lead to stomach ulcers and is associated with a higher risk of stomach cancer. Inflammation of your esophagus (esophagitis) can cause ulcers, scarring and cellular changes to your lining (Barretts Esophagus), which is occasionally a precursor to esophageal cancer.
#4 Bile Reflux: Symptoms, Treatment, Causes & What It Is
https://my.clevelandclinic.org/health/diseases/22056-bile-reflux
Bile reflux occurs when the valves that keep bile from backwashing into your stomach and esophagus arent working properly. Bile can erode the delicate linings of your stomach and esophagus, causing inflammation and tissue damage. […] Bile reflux occurs when bile from the small intestine backwashes into the stomach, and sometimes into the esophagus. […] Bile is composed of ingredients designed to digest fat. While it isnt an acidic formula, its harsh on the sensitive linings of your stomach and esophagus. Chronic bile reflux can erode these protective linings, causing painful inflammation and, eventually, tissue damage (esophagitis). […] Chronic inflammation of your stomach lining (gastritis) can lead to stomach ulcers and is associated with a higher risk of stomach cancer. Inflammation of your esophagus (esophagitis) can cause ulcers, scarring and cellular changes to your lining (Barretts Esophagus), which is occasionally a precursor to esophageal cancer.
#5 Bile reflux – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/symptoms-causes/syc-20370115
Bile reflux occurs when bile a digestive liquid produced in your liver backs up (refluxes) into your stomach and, in some cases, into the tube that connects your mouth and stomach (esophagus). […] Unlike gastric acid reflux, bile reflux can’t be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery. […] Make an appointment with your doctor if you frequently experience symptoms of reflux, or if you’re losing weight without trying. […] If you’ve been diagnosed with gastroesophageal reflux disease (GERD) but aren’t getting enough relief from your medications, call your doctor. You may need additional treatment for bile reflux. […] In cases of bile reflux, the valve doesn’t close properly, and bile washes back into the stomach. This can lead to inflammation of the stomach lining (bile reflux gastritis).
#6 Bile reflux – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/symptoms-causes/syc-20370115
Bile reflux may be caused by: […] Surgery complications. Stomach surgery, including total or partial removal of the stomach and gastric bypass surgery for weight loss, is responsible for most bile reflux. […] People who have had their gallbladders removed have significantly more bile reflux than do people who haven’t had this surgery. […] Bile reflux gastritis has been linked to stomach cancer. The combination of bile reflux and acid reflux also increases the risk of the following complications: […] Bile is often suspected of contributing to GERD when people respond incompletely or not at all to powerful acid-suppressant medications.
#7 Bile reflux | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/bile-reflux
Bile reflux occurs when bile a digestive liquid produced in your liver backs up (refluxes) into your stomach and, in some cases, into the tube that connects your mouth and stomach (esophagus). […] Unlike gastric acid reflux, bile reflux can’t be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery. […] Make an appointment with your doctor if you frequently experience symptoms of reflux, or if you’re losing weight without trying. […] If you’ve been diagnosed with GERD but aren’t getting enough relief from your medications, call your doctor. You may need additional treatment for bile reflux. […] Bile reflux may be caused by: […] Surgery complications. Stomach surgery, including total or partial removal of the stomach and gastric bypass surgery for weight loss, is responsible for most bile reflux.
#8 Bile reflux – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/symptoms-causes/syc-20370115
Bile reflux may be caused by: […] Surgery complications. Stomach surgery, including total or partial removal of the stomach and gastric bypass surgery for weight loss, is responsible for most bile reflux. […] People who have had their gallbladders removed have significantly more bile reflux than do people who haven’t had this surgery. […] Bile reflux gastritis has been linked to stomach cancer. The combination of bile reflux and acid reflux also increases the risk of the following complications: […] Bile is often suspected of contributing to GERD when people respond incompletely or not at all to powerful acid-suppressant medications.
#9 Bile reflux – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/symptoms-causes/syc-20370115
Bile reflux may be caused by: […] Surgery complications. Stomach surgery, including total or partial removal of the stomach and gastric bypass surgery for weight loss, is responsible for most bile reflux. […] People who have had their gallbladders removed have significantly more bile reflux than do people who haven’t had this surgery. […] Bile reflux gastritis has been linked to stomach cancer. The combination of bile reflux and acid reflux also increases the risk of the following complications: […] Bile is often suspected of contributing to GERD when people respond incompletely or not at all to powerful acid-suppressant medications.
#10 Bile Reflux: Clinical Considerations – Gastroenterology Advisor
https://www.gastroenterologyadvisor.com/features/tips-for-distinguishing-and-treating-biliary-reflux/
Bile reflux occurs when the bile secreted into the duodenum moves retrograde into the stomach and potentially into the esophagus. […] In certain patients with bile reflux, it has been postulated that a weak or widely patent pylorus could predispose patients to this condition. […] Patients who have undergone gastric surgeries where the pylorus is bypassed or disrupted may be predisposed to developing bile reflux as well. […] Identification of biliary reflux is important, as patients experiencing this can have more severe mucosal damage in the esophagus, including BE. […] Therefore, patients with evidence of bile reflux should be considered for more aggressive therapy, in the hopes of potentially preventing negative sequelae such as BE. […] There are no formal guidelines for treating patients with DGER; therefore, they are typically treated similarly to those with traditional GERD.
#11 GERD: Nursing Diagnosis & Interventions | Nurse.com
https://www.nurse.com/clinical-guides/gerd-gastroesophageal-reflux/?srsltid=AfmBOorzxsodaLQfvsD9j3p6LLVRecXC8q_k3eMqluu6HzDTTtcn2-Tv
Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for gastroesophageal reflux disease are listed below. […] Assess subjective findings: Nocturnal regurgitation, coughing or choking, dysphagia, epigastric pain, food intolerances, changes in taste, sore throat, weight loss, tooth discoloring, nausea and vomiting, sleep difficulty, anxiety. […] Assess objective findings: Vital signs, pain characteristics, weight, mouth and throat exam, breath sounds, anxiety level, knowledge of disease process, nutritional history. […] Develop plan of care and teaching plan. […] Manage epigastric pain. […] Promote avoidance of triggering medications and foods. […] Encourage diet modifications as prescribed.
#12 GERD: Nursing Diagnosis & Interventions | Nurse.com
https://www.nurse.com/clinical-guides/gerd-gastroesophageal-reflux/?srsltid=AfmBOorzxsodaLQfvsD9j3p6LLVRecXC8q_k3eMqluu6HzDTTtcn2-Tv
Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for gastroesophageal reflux disease are listed below. […] Assess subjective findings: Nocturnal regurgitation, coughing or choking, dysphagia, epigastric pain, food intolerances, changes in taste, sore throat, weight loss, tooth discoloring, nausea and vomiting, sleep difficulty, anxiety. […] Assess objective findings: Vital signs, pain characteristics, weight, mouth and throat exam, breath sounds, anxiety level, knowledge of disease process, nutritional history. […] Develop plan of care and teaching plan. […] Manage epigastric pain. […] Promote avoidance of triggering medications and foods. […] Encourage diet modifications as prescribed.
#13 Bile reflux | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/bile-reflux
Bile reflux occurs when bile a digestive liquid produced in your liver backs up (refluxes) into your stomach and, in some cases, into the tube that connects your mouth and stomach (esophagus). […] Unlike gastric acid reflux, bile reflux can’t be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery. […] Make an appointment with your doctor if you frequently experience symptoms of reflux, or if you’re losing weight without trying. […] If you’ve been diagnosed with GERD but aren’t getting enough relief from your medications, call your doctor. You may need additional treatment for bile reflux. […] Bile reflux may be caused by: […] Surgery complications. Stomach surgery, including total or partial removal of the stomach and gastric bypass surgery for weight loss, is responsible for most bile reflux.
#14 Bile reflux | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/bile-reflux
Make an appointment with your doctor if you have signs or symptoms common to bile reflux. After your doctor’s initial evaluation, you may be referred to a specialist in digestive disorders (gastroenterologist). […] Don’t hesitate to ask questions during your appointment. Some questions to ask your doctor include: […] What treatment approach do you recommend? […] Are there any lifestyle or dietary changes I can make to help reduce or manage my symptoms?
#15 Bile Reflux: Symptoms, Treatment, Causes & What It Is
https://my.clevelandclinic.org/health/diseases/22056-bile-reflux
Bile reflux occurs when the valves that keep bile from backwashing into your stomach and esophagus arent working properly. Bile can erode the delicate linings of your stomach and esophagus, causing inflammation and tissue damage. […] Bile reflux occurs when bile from the small intestine backwashes into the stomach, and sometimes into the esophagus. […] Bile is composed of ingredients designed to digest fat. While it isnt an acidic formula, its harsh on the sensitive linings of your stomach and esophagus. Chronic bile reflux can erode these protective linings, causing painful inflammation and, eventually, tissue damage (esophagitis). […] Chronic inflammation of your stomach lining (gastritis) can lead to stomach ulcers and is associated with a higher risk of stomach cancer. Inflammation of your esophagus (esophagitis) can cause ulcers, scarring and cellular changes to your lining (Barretts Esophagus), which is occasionally a precursor to esophageal cancer.
#16 Bile Reflux: Symptoms, Treatment, Causes & What It Is
https://my.clevelandclinic.org/health/diseases/22056-bile-reflux
Healthcare providers prescribe a variety of medications to treat bile reflux and its symptoms, but these have not been well studied. […] Medications to treat bile reflux include: Ursodeoxycholic acid (UDCA), which changes the content of bile in your stomach; Bile acid sequestrants, which bind and disrupt the circulation of bile; Sucralfate, which coats and protects the lining of your stomach and esophagus; Prokinetic agents to encourage motility between your stomach and small intestine; Baclofen, a medication that decreases the relaxation of your lower esophageal sphincter. […] Unlike acid reflux, bile reflux cant be treated with over-the-counter antacids or diet changes. Bile reflux is difficult to treat even with prescription medications. Sometimes, surgery is necessary. […] Prolonged exposure to bile can damage the linings of your stomach and esophagus. This can result in chronic inflammation, pain, and side effects such as ulcers.
#17 Bile reflux | Health Library | Memorial Health System
https://www.mhsystem.org/health-library/con-20370100/
Bile reflux may accompany the reflux of stomach acid (gastric acid) into your esophagus. Gastric reflux may lead to gastroesophageal reflux disease (GERD), a potentially serious problem that causes irritation and inflammation of esophageal tissue. […] Unlike gastric acid reflux, bile reflux cant be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery. […] Make an appointment with your doctor if you frequently experience symptoms of reflux, or if youre losing weight without trying. […] If youve been diagnosed with GERD but arent getting enough relief from your medications, call your doctor. You may need additional treatment for bile reflux. […] Bile reflux gastritis has been linked to stomach cancer. The combination of bile reflux and acid reflux also increases the risk of the following complications:
#18 Bile reflux – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/symptoms-causes/syc-20370115
Bile reflux may be caused by: […] Surgery complications. Stomach surgery, including total or partial removal of the stomach and gastric bypass surgery for weight loss, is responsible for most bile reflux. […] People who have had their gallbladders removed have significantly more bile reflux than do people who haven’t had this surgery. […] Bile reflux gastritis has been linked to stomach cancer. The combination of bile reflux and acid reflux also increases the risk of the following complications: […] Bile is often suspected of contributing to GERD when people respond incompletely or not at all to powerful acid-suppressant medications.
#19 Bile reflux | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/bile-reflux
Bile reflux occurs when bile a digestive liquid produced in your liver backs up (refluxes) into your stomach and, in some cases, into the tube that connects your mouth and stomach (esophagus). […] Unlike gastric acid reflux, bile reflux can’t be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery. […] Make an appointment with your doctor if you frequently experience symptoms of reflux, or if you’re losing weight without trying. […] If you’ve been diagnosed with GERD but aren’t getting enough relief from your medications, call your doctor. You may need additional treatment for bile reflux. […] Bile reflux may be caused by: […] Surgery complications. Stomach surgery, including total or partial removal of the stomach and gastric bypass surgery for weight loss, is responsible for most bile reflux.
#20
https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/bile-reflux
Bile reflux occurs when bile a digestive liquid produced in your liver backs up (refluxes) into your stomach and, in some cases, into the tube that connects your mouth and stomach (esophagus). […] Unlike gastric acid reflux, bile reflux can’t be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery. […] Make an appointment with your doctor if you frequently experience symptoms of reflux, or if you’re losing weight without trying. […] If you’ve been diagnosed with GERD but aren’t getting enough relief from your medications, call your doctor. You may need additional treatment for bile reflux. […] Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your stomach or esophagus.
#21 Bile Reflux: Symptoms, Treatment, Causes & What It Is
https://my.clevelandclinic.org/health/diseases/22056-bile-reflux
Healthcare providers prescribe a variety of medications to treat bile reflux and its symptoms, but these have not been well studied. […] Medications to treat bile reflux include: Ursodeoxycholic acid (UDCA), which changes the content of bile in your stomach; Bile acid sequestrants, which bind and disrupt the circulation of bile; Sucralfate, which coats and protects the lining of your stomach and esophagus; Prokinetic agents to encourage motility between your stomach and small intestine; Baclofen, a medication that decreases the relaxation of your lower esophageal sphincter. […] Unlike acid reflux, bile reflux cant be treated with over-the-counter antacids or diet changes. Bile reflux is difficult to treat even with prescription medications. Sometimes, surgery is necessary. […] Prolonged exposure to bile can damage the linings of your stomach and esophagus. This can result in chronic inflammation, pain, and side effects such as ulcers.
#22 Bile Reflux: Symptoms, Treatment, Causes & What It Is
https://my.clevelandclinic.org/health/diseases/22056-bile-reflux
Healthcare providers prescribe a variety of medications to treat bile reflux and its symptoms, but these have not been well studied. […] Medications to treat bile reflux include: Ursodeoxycholic acid (UDCA), which changes the content of bile in your stomach; Bile acid sequestrants, which bind and disrupt the circulation of bile; Sucralfate, which coats and protects the lining of your stomach and esophagus; Prokinetic agents to encourage motility between your stomach and small intestine; Baclofen, a medication that decreases the relaxation of your lower esophageal sphincter. […] Unlike acid reflux, bile reflux cant be treated with over-the-counter antacids or diet changes. Bile reflux is difficult to treat even with prescription medications. Sometimes, surgery is necessary. […] Prolonged exposure to bile can damage the linings of your stomach and esophagus. This can result in chronic inflammation, pain, and side effects such as ulcers.
#23 Bile Reflux: Clinical Considerations – Gastroenterology Advisor
https://www.gastroenterologyadvisor.com/features/tips-for-distinguishing-and-treating-biliary-reflux/
Treatment options include PPIs, H2RBs, prokinetics (metoclopramide), and baclofen (to reduce relaxation of the lower esophageal sphincter via gamma-aminobutyric acid B agonist action). […] It is also important to review a patients medication list and limit medications that could impair gastroduodenal motility, such as opioids and anticholinergics. […] When PPIs are used to treat DGER, the mechanism may be secondary to reducing gastric acid volume and overall acidity, although the alkaline nature of the bile reflux can still cause irritation of the esophagus. […] As with refractory GERD, surgery can also be considered in those patients with DGER who fail medical management.
#24 Bile Reflux: Clinical Considerations – Gastroenterology Advisor
https://www.gastroenterologyadvisor.com/features/tips-for-distinguishing-and-treating-biliary-reflux/
Treatment options include PPIs, H2RBs, prokinetics (metoclopramide), and baclofen (to reduce relaxation of the lower esophageal sphincter via gamma-aminobutyric acid B agonist action). […] It is also important to review a patients medication list and limit medications that could impair gastroduodenal motility, such as opioids and anticholinergics. […] When PPIs are used to treat DGER, the mechanism may be secondary to reducing gastric acid volume and overall acidity, although the alkaline nature of the bile reflux can still cause irritation of the esophagus. […] As with refractory GERD, surgery can also be considered in those patients with DGER who fail medical management.
#25 Bile Reflux: Clinical Considerations – Gastroenterology Advisor
https://www.gastroenterologyadvisor.com/features/tips-for-distinguishing-and-treating-biliary-reflux/
Treatment options include PPIs, H2RBs, prokinetics (metoclopramide), and baclofen (to reduce relaxation of the lower esophageal sphincter via gamma-aminobutyric acid B agonist action). […] It is also important to review a patients medication list and limit medications that could impair gastroduodenal motility, such as opioids and anticholinergics. […] When PPIs are used to treat DGER, the mechanism may be secondary to reducing gastric acid volume and overall acidity, although the alkaline nature of the bile reflux can still cause irritation of the esophagus. […] As with refractory GERD, surgery can also be considered in those patients with DGER who fail medical management.
#26 Bile Reflux: Symptoms, Treatment, Causes & What It Is
https://my.clevelandclinic.org/health/diseases/22056-bile-reflux
Healthcare providers prescribe a variety of medications to treat bile reflux and its symptoms, but these have not been well studied. […] Medications to treat bile reflux include: Ursodeoxycholic acid (UDCA), which changes the content of bile in your stomach; Bile acid sequestrants, which bind and disrupt the circulation of bile; Sucralfate, which coats and protects the lining of your stomach and esophagus; Prokinetic agents to encourage motility between your stomach and small intestine; Baclofen, a medication that decreases the relaxation of your lower esophageal sphincter. […] Unlike acid reflux, bile reflux cant be treated with over-the-counter antacids or diet changes. Bile reflux is difficult to treat even with prescription medications. Sometimes, surgery is necessary. […] Prolonged exposure to bile can damage the linings of your stomach and esophagus. This can result in chronic inflammation, pain, and side effects such as ulcers.
#27 Bile reflux – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/diagnosis-treatment/drc-20370121
Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms. […] Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your stomach or esophagus. […] Unlike acid reflux, bile reflux seems unrelated to lifestyle factors. But because many people experience both acid reflux and bile reflux, your symptoms may be eased by lifestyle changes: […] Some questions to ask your doctor include: Do I have bile reflux? What treatment approach do you recommend? Are there any side effects associated with these treatments? Are there any lifestyle or dietary changes I can make to help reduce or manage my symptoms? […] Your doctor is likely to ask you a number of questions. Being ready to answer them may give you time to go over points you want to spend more time on.
#28
https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/bile-reflux
Bile reflux occurs when bile a digestive liquid produced in your liver backs up (refluxes) into your stomach and, in some cases, into the tube that connects your mouth and stomach (esophagus). […] Unlike gastric acid reflux, bile reflux can’t be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery. […] Make an appointment with your doctor if you frequently experience symptoms of reflux, or if you’re losing weight without trying. […] If you’ve been diagnosed with GERD but aren’t getting enough relief from your medications, call your doctor. You may need additional treatment for bile reflux. […] Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your stomach or esophagus.
#29
https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/bile-reflux
Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor. […] During this type of surgery, a doctor creates a new connection for bile drainage farther down in the small intestine, diverting bile away from the stomach. […] The part of the stomach closest to the esophagus is wrapped and then sewn around the lower esophageal sphincter. This procedure strengthens the valve and can reduce acid reflux. However, there’s little evidence about the surgery’s effectiveness for bile reflux. […] Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms.
#30
https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/bile-reflux
Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor. […] During this type of surgery, a doctor creates a new connection for bile drainage farther down in the small intestine, diverting bile away from the stomach. […] The part of the stomach closest to the esophagus is wrapped and then sewn around the lower esophageal sphincter. This procedure strengthens the valve and can reduce acid reflux. However, there’s little evidence about the surgery’s effectiveness for bile reflux. […] Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms.
#31
https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/bile-reflux
Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor. […] During this type of surgery, a doctor creates a new connection for bile drainage farther down in the small intestine, diverting bile away from the stomach. […] The part of the stomach closest to the esophagus is wrapped and then sewn around the lower esophageal sphincter. This procedure strengthens the valve and can reduce acid reflux. However, there’s little evidence about the surgery’s effectiveness for bile reflux. […] Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms.
#32 Gastroesophageal Reflux Nursing Care Management – Nurseslabs
https://nurseslabs.com/gastroesophageal-reflux/
Nursing care for a child with gastroesophageal reflux includes the following: […] Assessment of the child includes: […] One must remember that the typical symptoms (eg, heartburn, vomiting, regurgitation) in adults cannot be readily assessed in infants and children; pediatric patients with gastroesophageal reflux typically cry and report sleep disturbance and decreased appetite. […] Based on the assessment data, the major nursing diagnosis is: […] The major nursing care planning goals for a child with gastroesophageal reflux: […] Nursing interventions for a child with gastroesophageal reflux are: […] Goals are met as evidenced by: […] Documentation in a child with gastroesophageal reflux includes:
#33 GERD: Nursing Diagnosis & Interventions | Nurse.com
https://www.nurse.com/clinical-guides/gerd-gastroesophageal-reflux/?srsltid=AfmBOorzxsodaLQfvsD9j3p6LLVRecXC8q_k3eMqluu6HzDTTtcn2-Tv
Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for gastroesophageal reflux disease are listed below. […] Assess subjective findings: Nocturnal regurgitation, coughing or choking, dysphagia, epigastric pain, food intolerances, changes in taste, sore throat, weight loss, tooth discoloring, nausea and vomiting, sleep difficulty, anxiety. […] Assess objective findings: Vital signs, pain characteristics, weight, mouth and throat exam, breath sounds, anxiety level, knowledge of disease process, nutritional history. […] Develop plan of care and teaching plan. […] Manage epigastric pain. […] Promote avoidance of triggering medications and foods. […] Encourage diet modifications as prescribed.
#34 GERD: Nursing Diagnosis & Interventions | Nurse.com
https://www.nurse.com/clinical-guides/gerd-gastroesophageal-reflux/?srsltid=AfmBOorzxsodaLQfvsD9j3p6LLVRecXC8q_k3eMqluu6HzDTTtcn2-Tv
Support a relaxing atmosphere. […] Encourage routine weight monitoring. […] Encourage relaxation techniques. […] Include individual in creation of teaching plan. […] Provide clear explanations and demonstrations. […] Administer medications as ordered. […] Demonstrates reduced anxiety levels. […] Reports decreased pain. […] Maintains nutritional requirements. […] Demonstrates/verbalizes understanding of condition, prevention, and management. […] Remains free from complications. […] General information about diagnosis and treatments, recognition of symptom progression, diet and lifestyle changes, support resources available. […] Medications they are prescribed and teach them to take medicine as directed, report any medication side effects. […] Call the provider if your pain or symptoms worsen, there are questions or concerns about the condition or care. […] Recommended follow-up with healthcare provider.
#35 GERD: Nursing Diagnosis & Interventions | Nurse.com
https://www.nurse.com/clinical-guides/gerd-gastroesophageal-reflux/?srsltid=AfmBOorzxsodaLQfvsD9j3p6LLVRecXC8q_k3eMqluu6HzDTTtcn2-Tv
Support a relaxing atmosphere. […] Encourage routine weight monitoring. […] Encourage relaxation techniques. […] Include individual in creation of teaching plan. […] Provide clear explanations and demonstrations. […] Administer medications as ordered. […] Demonstrates reduced anxiety levels. […] Reports decreased pain. […] Maintains nutritional requirements. […] Demonstrates/verbalizes understanding of condition, prevention, and management. […] Remains free from complications. […] General information about diagnosis and treatments, recognition of symptom progression, diet and lifestyle changes, support resources available. […] Medications they are prescribed and teach them to take medicine as directed, report any medication side effects. […] Call the provider if your pain or symptoms worsen, there are questions or concerns about the condition or care. […] Recommended follow-up with healthcare provider.
#36 Esophageal acid and bile reflux in mechanically ventilated patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC3301333/
Previous studies using scintigraphy have documented a high incidence (61%) of gastroesophageal reflux in mechanically ventilated (MV) patients. […] The aim of this study was to assess, over a prolonged period of time, the incidence and type (bile or acid) of reflux, the effect of body position on reflux, and the potential relationship between pathological reflux and esophagitis in mechanically ventilated patients. […] 12 of 24 patients (50%) had pathological DGER (median % reflux time over the whole recording time independent of body position: 8%, IQR 0.62%). […] Under standard stress ulcer prophylaxis with ranitidine, critically ill patients with MV have a high incidence (50%) of DGER but not of acidic esophageal reflux. […] The presence of bile salts in the esophagus for prolonged periods of time suggest that: 1) the barrier function of the LES and the clearance function of the esophagus are deranged, 2) esophagitis in these patients may not only be a result of mechanical irritation due to the nasogastric tube, but may also be a chemical esophagitis, 3) intestinal fluids refluxing into the esophagus may be conducive to ventilator-associated pneumonia.
#37 Esophageal acid and bile reflux in mechanically ventilated patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC3301333/
Previous studies using scintigraphy have documented a high incidence (61%) of gastroesophageal reflux in mechanically ventilated (MV) patients. […] The aim of this study was to assess, over a prolonged period of time, the incidence and type (bile or acid) of reflux, the effect of body position on reflux, and the potential relationship between pathological reflux and esophagitis in mechanically ventilated patients. […] 12 of 24 patients (50%) had pathological DGER (median % reflux time over the whole recording time independent of body position: 8%, IQR 0.62%). […] Under standard stress ulcer prophylaxis with ranitidine, critically ill patients with MV have a high incidence (50%) of DGER but not of acidic esophageal reflux. […] The presence of bile salts in the esophagus for prolonged periods of time suggest that: 1) the barrier function of the LES and the clearance function of the esophagus are deranged, 2) esophagitis in these patients may not only be a result of mechanical irritation due to the nasogastric tube, but may also be a chemical esophagitis, 3) intestinal fluids refluxing into the esophagus may be conducive to ventilator-associated pneumonia.
#38 Esophageal acid and bile reflux in mechanically ventilated patients | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/cc221
Previous studies using scintigraphy have documented a high incidence (61%) of gastroesophageal reflux in mechanically ventilated (MV) patients. […] The aim of this study was to assess, over a prolonged period of time, the incidence and type (bile or acid) of reflux, the effect of body position on reflux, and the potential relationship between pathological reflux and esophagitis in mechanically ventilated patients. […] 12 of 24 patients (50%) patients had pathological DGER (median % reflux time over the whole recording time independent of body position: 8%, IQR 0.62%). […] In contrast, only one patient had significant acid reflux (4.8% of the recording time) and the median pH in the lower esophagus for all 24 patients was 6.7 (IQR 6.7). […] The relative time of pathological reflux was significantly higher in left lateral and supine position as compared to right lateral position (7.1% IQR 0.64% and 8%, IQR 0.65% vs. 4.7% IQR 0.70%, P 0.01.
#39 Esophageal acid and bile reflux in mechanically ventilated patients
https://pmc.ncbi.nlm.nih.gov/articles/PMC3301333/
Previous studies using scintigraphy have documented a high incidence (61%) of gastroesophageal reflux in mechanically ventilated (MV) patients. […] The aim of this study was to assess, over a prolonged period of time, the incidence and type (bile or acid) of reflux, the effect of body position on reflux, and the potential relationship between pathological reflux and esophagitis in mechanically ventilated patients. […] 12 of 24 patients (50%) had pathological DGER (median % reflux time over the whole recording time independent of body position: 8%, IQR 0.62%). […] Under standard stress ulcer prophylaxis with ranitidine, critically ill patients with MV have a high incidence (50%) of DGER but not of acidic esophageal reflux. […] The presence of bile salts in the esophagus for prolonged periods of time suggest that: 1) the barrier function of the LES and the clearance function of the esophagus are deranged, 2) esophagitis in these patients may not only be a result of mechanical irritation due to the nasogastric tube, but may also be a chemical esophagitis, 3) intestinal fluids refluxing into the esophagus may be conducive to ventilator-associated pneumonia.
#40 Esophageal acid and bile reflux in mechanically ventilated patients | Critical Care | Full Text
https://ccforum.biomedcentral.com/articles/10.1186/cc221
12 of 24 patients (50%) had esophagitis. […] There was a significant positive relationship between the presence of pathological DGER and the presence of esophagitis (P = 0.04). […] Under standard stress ulcer prophylaxis with ranitidine, critically ill patients with MV have a high incidence (50%) of DGER but not of acidic esophageal reflux. […] The presence of bile salts in the esophagus for prolonged periods of time suggest that: 1) the barrier function of the LES and the clearance function of the esophagus are deranged, 2) esophagitis in these patients may not only be a result of mechanical irritation due to the nasogastric tube, but may also be a chemical esophagitis, 3) intestinal fluids refluxing into the esophagus may be conducive to ventilator-associated pneumonia.
#41 Does Bile Reflux Increase Following Cholecystectomy? – Houston Heartburn and Reflux Center
https://houstonheartburn.com/does-bile-reflux-increase-following-cholecystectomy/
âGastroesophageal Mucosal Injury after Cholecystectomy: An Indication for Surveillance?â is a new study published by T. Walsh et al in the current issue of JACS (Journal of the American College of Surgeons). The analysis show that cholecystectomy increases the incidence of bile reflux and bile induced damage of gastric and esophageal mucosa. […] This study shows that cholecystectomy increases the risk of bile reflux and esophago-gastric mucosa injury. […] I suspect the risk of bile reflux and mucosal injury is highest in GERD patients who undergo an unindicated cholecystectomy.
#42 Does Bile Reflux Increase Following Cholecystectomy? – Houston Heartburn and Reflux Center
https://houstonheartburn.com/does-bile-reflux-increase-following-cholecystectomy/
âGastroesophageal Mucosal Injury after Cholecystectomy: An Indication for Surveillance?â is a new study published by T. Walsh et al in the current issue of JACS (Journal of the American College of Surgeons). The analysis show that cholecystectomy increases the incidence of bile reflux and bile induced damage of gastric and esophageal mucosa. […] This study shows that cholecystectomy increases the risk of bile reflux and esophago-gastric mucosa injury. […] I suspect the risk of bile reflux and mucosal injury is highest in GERD patients who undergo an unindicated cholecystectomy.
#43 Medical management of acid/bile reflux before, during and after endoscopic therapy for Barrettâs esophagus: a narrative review – Jaswani – Annals of Esophagus
https://aoe.amegroups.org/article/view/5859/html
Bile reflux or duodenogastric reflux has been proposed in the etiology of BE as bile acids have been found in the refluxate of patients with BE. It has been suggested that bile acids may exert their effects on the esophageal mucosa through cytotoxic pathways and upregulation of proto-oncogene and c-myc resulting in inflammation and contributing to the inflammation-cancer cascade. […] Inadequate acid suppression defined by impedance-pH monitoring is a modifiable risk factor and increases the risk of recurrence of intestinal metaplasia (IM) after EET. Ongoing distal esophageal reflux, both acid and non-acid is also associated with incomplete response to EET. This observation highlights the importance of aggressive pharmacologic acid suppression and also reminds us of the role of lifestyle modifications in decreasing distal esophageal reflux exposure both during and after the EET period.
#44 Medical management of acid/bile reflux before, during and after endoscopic therapy for Barrettâs esophagus: a narrative review – Jaswani – Annals of Esophagus
https://aoe.amegroups.org/article/view/5859/html
Bile reflux or duodenogastric reflux has been proposed in the etiology of BE as bile acids have been found in the refluxate of patients with BE. It has been suggested that bile acids may exert their effects on the esophageal mucosa through cytotoxic pathways and upregulation of proto-oncogene and c-myc resulting in inflammation and contributing to the inflammation-cancer cascade. […] Inadequate acid suppression defined by impedance-pH monitoring is a modifiable risk factor and increases the risk of recurrence of intestinal metaplasia (IM) after EET. Ongoing distal esophageal reflux, both acid and non-acid is also associated with incomplete response to EET. This observation highlights the importance of aggressive pharmacologic acid suppression and also reminds us of the role of lifestyle modifications in decreasing distal esophageal reflux exposure both during and after the EET period.
#45 Bile reflux – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/diagnosis-treatment/drc-20370121
Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms. […] Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your stomach or esophagus. […] Unlike acid reflux, bile reflux seems unrelated to lifestyle factors. But because many people experience both acid reflux and bile reflux, your symptoms may be eased by lifestyle changes: […] Some questions to ask your doctor include: Do I have bile reflux? What treatment approach do you recommend? Are there any side effects associated with these treatments? Are there any lifestyle or dietary changes I can make to help reduce or manage my symptoms? […] Your doctor is likely to ask you a number of questions. Being ready to answer them may give you time to go over points you want to spend more time on.
#46
https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/bile-reflux
Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor. […] During this type of surgery, a doctor creates a new connection for bile drainage farther down in the small intestine, diverting bile away from the stomach. […] The part of the stomach closest to the esophagus is wrapped and then sewn around the lower esophageal sphincter. This procedure strengthens the valve and can reduce acid reflux. However, there’s little evidence about the surgery’s effectiveness for bile reflux. […] Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms.
#47 Bile reflux | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/bile-reflux
Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your stomach or esophagus. […] Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor. […] During this type of surgery, a doctor creates a new connection for bile drainage farther down in the small intestine, diverting bile away from the stomach. […] The part of the stomach closest to the esophagus is wrapped and then sewn around the lower esophageal sphincter. This procedure strengthens the valve and can reduce acid reflux. However, there’s little evidence about the surgery’s effectiveness for bile reflux. […] Unlike acid reflux, bile reflux seems unrelated to lifestyle factors. But because many people experience both acid reflux and bile reflux, your symptoms may be eased by lifestyle changes:
#48 Bile reflux | Health Library | Memorial Health System
https://www.mhsystem.org/health-library/con-20370100/
Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your stomach or esophagus. […] Some types of surgery can be more successful than others, so be sure to discuss the pros and cons carefully with your doctor. […] During this type of surgery, a doctor creates a new connection for bile drainage farther down in the small intestine, diverting bile away from the stomach. […] The part of the stomach closest to the esophagus is wrapped and then sewn around the lower esophageal sphincter. This procedure strengthens the valve and can reduce acid reflux. However, theres little evidence about the surgerys effectiveness for bile reflux. […] Unlike acid reflux, bile reflux seems unrelated to lifestyle factors. But because many people experience both acid reflux and bile reflux, your symptoms may be eased by lifestyle changes:
#49 Bile reflux | Beacon Health System
https://www.beaconhealthsystem.org/library/diseases-and-conditions/bile-reflux?content_id=CON-20370100
Don’t hesitate to ask questions during your appointment. Some questions to ask your doctor include: Do I have bile reflux? What treatment approach do you recommend? Are there any side effects associated with these treatments? Are there any lifestyle or dietary changes I can make to help reduce or manage my symptoms? I have other health conditions. How can I best manage them together?
#50 Bile reflux – Diagnosis & treatment – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/bile-reflux/diagnosis-treatment/drc-20370121
Lifestyle adjustments and medications can be very effective for acid reflux into the esophagus, but bile reflux is harder to treat. There is little evidence assessing the effectiveness of bile reflux treatments, in part because of the difficulty of establishing bile reflux as the cause of symptoms. […] Doctors may recommend surgery if medications fail to reduce severe symptoms or there are precancerous changes in your stomach or esophagus. […] Unlike acid reflux, bile reflux seems unrelated to lifestyle factors. But because many people experience both acid reflux and bile reflux, your symptoms may be eased by lifestyle changes: […] Some questions to ask your doctor include: Do I have bile reflux? What treatment approach do you recommend? Are there any side effects associated with these treatments? Are there any lifestyle or dietary changes I can make to help reduce or manage my symptoms? […] Your doctor is likely to ask you a number of questions. Being ready to answer them may give you time to go over points you want to spend more time on.
#51 Reflux and Gastrointestinal Surgery Program | TriHealth
https://www.trihealth.com/services/trihealth-surgical-care/key-services/reflux-and-gastrointestinal-surgery-program
The Reflux and Gastrointestinal Surgery Program within the TriHealth Surgical Institute offers integrated care and surgical expertise in the management and treatment of conditions affecting the esophagus, stomach, and the duodenum. Our program brings together specialty experts including gastroenterologists, surgeons, otolaryngologists and radiologists to assure comprehensive care from diagnosis through treatment. This team is dedicated to the assessment and individualized care plan to meet each patients unique needs and preferences. […] As part of our integrated, multi-disciplinary approach to your care, we work closely with specialists across the board, including physicians and practitioners from Gastroenterology, Trihealth Weight Management Program and TriHealth Cancer Blood Institute, as well your primary care physician, nurses, and nutritionists, to develop the best plan for you. We want to assure seamless return to the care of your primary care physician following your treatment success.
#52 Reflux and Esophageal Disorders Center | Orlando Health
https://www.orlandohealth.com/services-and-specialties/reflux-and-esophageal-disorders-center
We understand the challenges that can come with gastroesophageal reflux disease (GERD) and other esophageal issues, and our compassionate team of experts is dedicated to working closely with you to craft a customized care plan tailored to your unique needs. […] If you have acid reflux or have been diagnosed with an esophageal disorder, our team is ready to evaluate you and develop a treatment plan that is right for you. […] The Orlando Health Reflux and Esophageal Disorders Center will design a care plan tailored to your specific condition. This could include a combination of nonsurgical and surgical treatments. […] Our specialized team includes gastroenterologists; ear, nose and throat specialists; motility specialists; surgeons; dietitians; nurses and speech therapists. They are trained in the latest surgical and nonsurgical treatments available for the full range of esophageal disorders.
#53 Reflux and Gastrointestinal Surgery Program | TriHealth
https://www.trihealth.com/services/trihealth-surgical-care/key-services/reflux-and-gastrointestinal-surgery-program
The Reflux and Gastrointestinal Surgery Program within the TriHealth Surgical Institute offers integrated care and surgical expertise in the management and treatment of conditions affecting the esophagus, stomach, and the duodenum. Our program brings together specialty experts including gastroenterologists, surgeons, otolaryngologists and radiologists to assure comprehensive care from diagnosis through treatment. This team is dedicated to the assessment and individualized care plan to meet each patients unique needs and preferences. […] As part of our integrated, multi-disciplinary approach to your care, we work closely with specialists across the board, including physicians and practitioners from Gastroenterology, Trihealth Weight Management Program and TriHealth Cancer Blood Institute, as well your primary care physician, nurses, and nutritionists, to develop the best plan for you. We want to assure seamless return to the care of your primary care physician following your treatment success.
#54 Reflux and Gastrointestinal Surgery Program | TriHealth
https://www.trihealth.com/services/trihealth-surgical-care/key-services/reflux-and-gastrointestinal-surgery-program
If surgery is part of that plan, our program surgeons specialize in these types of surgeries. With this specialization comes their ability to perform higher volumes in these types of surgery which research has demonstrated, leads to better outcomes. They use state of the art technology and perform surgeries almost entirely using minimally invasive techniques. Minimally invasive surgical approaches, including robotic and laparoscopic surgery, are just a few examples of the advanced techniques utilized by our team. Advantages of such methods include: […] Smaller incisions, less pain, and less requirement for pain medications […] Shorter hospital stay […] Faster recovery with earlier recovery of bowel function and resumption of eating […] Earlier return to work/ full activity.